Sales reps' presence tied to heart stent use: study

By Andrew M. Seaman| NEW YORK

NEW YORK (Reuters Health) - Having sales representatives from medical device companies at hospitals may influence which products doctors use and ultimately drive up costs, according to a new study from Canada.

Researchers found that doctors were more likely to use a company's drug-coated heart stent when one of its sales representatives visited their hospital, which resulted in about a $250 higher bill per case.

"We need to evaluate carefully any interactions with medical industry to ensure that we minimize an effect on our decision making process," wrote Dr. Shahar Lavi, the study's lead author, in an email to Reuters Health.

Sales representatives may help doctors get better acquainted with a certain product or new technology, but the relationships between drug and medical device companies and doctors have come under increased scrutiny in recent years.

For example, some professional organizations have also adopted ethics codes to help manage those interactions, write the authors in the American Heart Journal.

For the new study, Lavi, of London Health Sciences Center in Ontario, and colleagues looked at the possible influence of sales representatives' visits to their center on stenting procedures performed there between 2008 and 2009.

During stenting, a balloon-tipped catheter is threaded through blood vessels in the wrist or thigh toward the heart. The balloon is inflated to clear one or more narrowed vessels, then, in most cases, a small mesh tube known as a stent is used to prop each vessel open.

Overall, doctors performed 1,178 stenting procedures on 1,109 patients during the study. Sales representatives were present for 563 of those procedures.

Most of the stents were so-called drug-eluting stents, which release a drug to help keep the arteries from becoming blocked but are more expensive than bare-metal stents.

Liberal use of drug-eluting stents, however, has not been shown to lower deaths or heart attacks and one study showed bare-metal stents work fine in low-risk patients (see Reuters Health story of July 9, 2012 here:).

The researchers found that drug-eluting stents were used in about 56 percent of procedures when a sales representative was at the hospital, compared to about 51 percent of procedures when they weren't there.

The presence of a sales representative was also tied to an increased use of the drug-eluting stents their companies manufacture.

What's more, stenting procedures - on average - cost $1,703 when a representative was present, compared to $1,468 when they were not.

HOSPITALS CHANGE POLICIES

Dr. Theodore Bass, president of The Society for Cardiovascular Angiography and Interventions, said he's not surprised by the findings, because 2008 and 2009 were when new developments in stenting technologies were emerging.

"Since that time, at least most academic centers… have very tight rules and regulations governing these activities," said Bass, who was not involved in the new study.

Indeed, the researchers wrote that their hospital has changed its policy toward sales representatives in the wake of their findings. Subsequently, the ratio of drug-eluting and bare-metal stents fell.

"We don't allow representatives in the working area unless they are needed for training," Lavi said.

In a statement to Reuters Health, Dr. Terry Chang, associate general counsel and director of legal and medical affairs at the Advanced Medical Technology Association - a medical technology trade association - said interactions between sales representatives and doctors benefit patients and are supported by professional medical organizations.

"The medical technology industry strives to ensure that collaborative relationships between physicians and industry representatives meet the highest ethical standards, are conducted with appropriate transparency and are in compliance with applicable laws, regulations and government guidance," Chang said.

"I can tell you I'm very comfortable telling patients in these (academic) centers it's a thing of the past. That's not to say there aren't outliers, but I haven't looked," Bass, who is also chief of the division of cardiology at University of Florida Health at Jacksonville," said.

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